SCAD and Atypical Chest Pain: A Simple Check, or a Trap?

A 47-year-old woman with a history of multiple previous spontaneous coronary artery dissection (SCAD) episodes, treated both conservatively and with percutaneous coronary intervention (PCI), was referred for coronary angiography due to atypical chest pain. The purpose of the exam was to reassess coronary anatomy and exclude recurrent dissection or ischemia-related stenosis. Angiography showed an optimal result of the prior left anterior descending (LAD) stenting and complete healing of the distal right coronary artery (RCA), previously involved in her last event. However, during a final control injection, a large iatrogenic dissection occurred, extending from the left main (LM) into both the LAD and left circumflex (LCx). True lumen wiring of both vessels was achieved, followed by OCT-guided stenting, leading to full hemodynamic stabilization. This case highlights the potential risks associated with invasive assessment in SCAD patients, emphasizing the importance of careful procedural planning. Noninvasive follow-up (e.g., CCTA) should be considered whenever feasible, and operators must remain prepared to manage potential severe complications during the procedure.